maternal

1. Maternal and Child Nursing
University of Santo Tomas – College of Nursing / JSV
Factors that Affect Labor
Passage
 Pelvis (more important)
o Assessed through pelvimetry
o Hip bones (innominate bones)
 Ilium, ischium and pubis, coccyx,
sacrum
o False Pelvis- where the uterus is
o Linea terminalis- separates false pelvis from true
pelvis
o True Pelvis
o Diagonal Conjugate
 DIstrance of anterior margin of the
pubic to the sacrum (pelvic inlet)
 Widest anteroposterior diameter
 11.5-12.5cm
o True Conjugate (Vera)
 From lower margin of pubis to sacrum
 Less than 1.5 or 2 cm from the diagonal
conjugate
o Ischial Diameter (bi-ischial/inter-tuberous)
 Outlet (transverse diameter)
 Always greater than 8 cm
o Gynecoid
 Round-shaped; most ideal
 Wide antero-posterior diameter
o Anthropoid
 Wide inlet, narrow outlet
 Allows vaginal delivery through forceps
o Platypelloid
 Oval
 Wide transverse, narrow AP diameter
 Wide inlet, narrow outlet
 CS delivery
o Android
 Pelvis that is narrow on all sides
 We are all android before
 Bone of women thins  widens
 Height less than 4”10
o Linea Terminalis
 Imaginary line that separates the false
from the true pelvis
o Cephalopelvic Disproportion
 Baby’s head size is not in proportion to
the maternal pelvic size
 Soft tissues
Passenger
 Size of the fetal head – presenting part
o AP diameter
o Occipitomentum- 13.5
o Occipitofrontal- 12
o Suboccipitobragmatic- 9.5
o Biparietal- 9
o Bi-temporal- 8
o Bimastoid- 7
 Fetal attitude/habitus - degree of flexion of a part
 Fetal position – relation of the point of reference
(denominator) to the quadrants of the pelvic inlet, where
the occiput (cephalic), buttocks (breech), or shoulder
blade(acromio) is facing
 Fetal lie – relationship of fetal long axis and long axis of
mother
 Fetal presentation – part seen first the fetus that is lying in
the inlet or at the cervical os
o Cephalic
 Vertex (occiput) - well flexed head
 Brow (sinciput) - moderately flexed
head
 Face - exaggerated extension of the
head
 Mentum – chin presentation
o Breech
 Complete
 Flexed at thighs and flexed at
knees
 Squatting position
 Buttocks and legs are
presented
 Difficult to deliver because it
has 2 presenting parts
(compound presentation) -
CS delivery
 Frank
 Flexed at the thighs and
extended at the knees
 Head cannot flex on its way
out  Mariceu’s Maneuver –
attempt to flex the head in a
breech delivery
 Use of Piper’s forceps –
forceps on the chin to flex
 Incomplete/Footling
 Legs are extended
 Single or Double footling
o Shoulder
 Baby is on a transverse lie
o Persistent Occiput Posterior/ Back Labor
 Arrested after 45 degrees
 Position: side-lying
 Back rub/ sacral massage
 Delivery position: side lying
 Fetal Station – degree of descent on the ischial spine,
relationship of the presenting part to the level of the ischial
spine
o (-) – floating
o 0 – at the level of ischial spines
o (+) – engaged
o +3 – crowning
 Seen at the vulva
o Primi – 1 hour per station
o Multigravida – 30 mins per station
The relationship between the passage and fetus
 Ischial Spine
 Stations
Powers (Physiologic forces)
 Primary: Uterine Contraction - involuntary; contracts due
to
o Hormone release
o Uterine Stretch theory
 Secondary: Intra-abdominal Pressure – voluntary
o Small amount of pushing
o Done on second and third stage
Duration – start to end of contraction A-C
Interval – space between two contraction C-D
Frequency – start to start of each contraction A-D
Intensity – hardness of the abdomen
o Assessed using tocodynamometer
Frequency and duration increases are labor progresses
Interval becomes shorter as labor progresses

2. Maternal and Child Nursing
University of Santo Tomas – College of Nursing / JSV
Psychosocial Considerations
 Fear + Anxiety = Pain
o Reduce fear and anxiety
o Gate Control Theory
 Substantiagelatinosa
 Open gate- pain
 Close- no pain
o To close the gate: diversion/distract the mother
 Birth Center - relatives can be with the mother
 LDR Room - labor delivery recovery
 Water Birth - Baby is a good swimmer  adjustment is
faster
Position
- Described the relation of the point of reference
(denominator) to the quadrants of the pelvic inlet
3 Reasons for Lithotomy Position
- Use forceps
- Physician intends suture
- Baby is in breech position
Signs of True Labor vs. False
1. Location – abdomen radiating to the back
2. Positional changes – intensifies the pain (if relieved by
walking, false)
3. Rhythm – regular
4. Cervix – dilated
STAGES OF LABOR AND DELIVERY
Stage 1: Cervical Dilation and Effacement
 Begins with true labor and ends with cervical dilatation
and effacement
 Effacement first before dilation
o Fully effaced- both internal and external os meet
 Multipara- almost the same time for dilation and
effacement
 Duration: 12-18 hours for primi; 6-8 hours for multi
 Prolonged Labor
o Greater than 18 hours in a primi
o Greater than 12 hours in a multi
 Precipitate labor
o faster than 3 hours
o danger of laceration and head injury
o May be given tocolytic (Bricanyl) can be given
for women who are: grand multi, premature
babies in good position, overuse of oxytocin,
large pelvis
HYPOTONIC HYPERTONIC
Decreased intensity when
woman has entered Active
phase
Strong intensity at the start of
labor (latent phase)
There 2 sources of contraction
Cervix will not dilate
Cause fetal distress
At risk = multi At risk = primi
Tx: oxytocin
For every hour oxytocin,
there should be 1 cm
cervical dilation
If not responding  CS
Tx: Morphine
Causes respiratory distress
-labor can progress
Why not tocolytic?? Uterus
might not contract
 Pacemaker- start of contraction
o Fundus
Phases of First Stage
Latent Active Transition
0-3 cm 4-7 8-10
Intervals: 5-30
minutes
3-5 minutes 2-3 minutes
Duration: 30 sec 45-60 60-80
Calm, walking Irritable,
Narcissistic
Behavioral change,
may lose control
 Latent Phase
o Time when woman is most comfortable; not in
pain
o Multipara- go to the hospital agad
o Primipara had lightening, after 2 weeks goes into
labor
o Multipara had lightening, labor the same day
o Nsg Dx: Anxiety and knowledge deficit; update
her of the status
o Interventions:
 Upright position to make the baby
descend faster, deep breathing
exercise, clear liquid diet, BP q1, FHT
q30

 Active Phase
o When the patient can’t handle the pain, give
pain meds
 Demerol (meperidine hydrochloride)
 Antidote: naloxone
o Phenergan- reduce secretion
 Potentiates the effect of Demerol
 Get RR and FHR
o Nsg Dx: Acute pain
o Interventions:
 Breathing: Pursed-lip
breathing/accelerated breathing
 Massage (effleurage) - light stroking of
the abdomen
 Pain relief (Demerol, Nubain) – given at
5 to 6 cm
 Antidote: Narcan/Naloxone
 Change position
 Acupressure
 Hoku acupressure point-
improve contraction but not
increase the pain
 NPO with IVF
 Left side lying
 Activity: None
 BR on her side
 FHT q 15, BP q30
o Fetal Monitoring
 Early deceleration (before acme)
 head compression,
 no variability
 continue monitoring
 Late deceleration
 Uteroplacental insufficiency
 Fetal distress
 Nsg care:
o Turn off pitocin
o Side-lying
o Start oxygen
o Call the
doctor(anticipate
CS)
 Oxytocin stress test